# LAURA C. RANDOLPH MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255527727
- **Authorized official:** RITA DEMPSEY (OFFICE MANAGER)
- **Authorized official phone:** (309) 664-6222

## Contact information

- **Practice address:** 2502 E EMPIRE ST, SUITE C, BLOOMINGTON, IL 61704-3738
- **Practice address phone:** (309) 664-6222
- **Practice address fax:** (309) 664-5006
- **Mailing address:** 2502 E EMPIRE ST, SUITE C, BLOOMINGTON, IL 61704-3738
- **Mailing address phone:** (309) 664-6222
- **Mailing address fax:** (309) 664-5006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 36100030 | IL | Yes |

## Other

- **Enumeration date:** 09/19/2007
- **Last updated:** 09/19/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 097565 | HEALTH ALLIANCE | IL |
| 01 | — | 5732066 | BLUE CROSS BLUE SHIELD | IL |
| 01 | — | 686867 | HEALTH LINK | IL |
| 01 | — | P00193845 | RAILROAD MEDICARE | IL |